A 57-year-old woman was admitted to JR Sapporo General Hospital with the complaint of dyspnea and palpitation following photogastroscopy. A chest roentgenogram revealed a simultaneous bilateral spontaneous pneumothorax. Video-assisted thoracoscopy demonstrated multiple holes and nodules at the top of the right diaphragm and a ruptured bulla in the left lower lobe. These abnormalities were successfully repaired in a single stage procedure using video-assisted thoracoscopy. This procedure is beneficial in the treatment of this rare condition.

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